POS0300 PATIENT ACCEPTABLE SYMPTOM STATE IN RELATION TO DISEASE ACTIVITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS FROM A LARGE STANDARD-OF-CARE COHORT
Authors: M. Carbo, A. Kampman, D. Paap, F. Wink, A. Spoorenberg, S. Arends
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The patient acceptable symptom state (PASS) is the level beyond which patients consider themselves well. This concept can help to interpret results of clinical trials and enhance physician-patient communication in daily clinical practice.(1) <h3>Objectives</h3> To explore the association of PASS with disease activity according to ASDAS and other patient- and disease characteristics in a large standard-of-care cohort of patients with in axial spondyloarthritis (axSpA). <h3>Methods</h3> Patients from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort visiting the outpatient clinic between May 2016 and October 2019 were included in this cross-sectional analysis. Patient characteristics and clinical assessments were measured according to the standardized GLAS protocol. Additionally, patients were asked to fill out the PASS question: "Considering all the different ways axSpA is affecting you and if you stay in this state for the next months, do you consider your current state satisfactory? ("yes": PASS/"no": non-PASS). Logistic regression analysis was used to explore patient and disease characteristics associated with PASS. ROC analysis with area under the curve (AUC) was used to analyze the accuracy of the ASDAS and the optimal cut-off point to predict PASS according to the highest Youden's index. <h3>Results</h3> Of the 673 included axSpA patients, 63% were male, mean was age 48±14 years, median symptom duration 19 (11-31) years and mean ASDAS 2.3 (±0.9). In total, the vast majority (76%) reported an acceptable symptom state according to the PASS question. Patients in the PASS group had significantly lower ASDAS compared to the non-PASS group (mean 2.0 ±0.8 vs. 3.2 ±0.8). Patients with an acceptable symptom state also had significantly lower BASDAI scores, were more often male, had longer symptom duration, had less tender entheses, used less often NSAIDs, experienced better physical function (BASFI) and quality of life (ASQoL), and had less radiographic damage (mSASSS) (Table 1). In multivariable regression analysis, lower ASDAS (OR: 4.45 (3.26-6.09)), longer symptom duration (OR 0.97 (0.95-0.99)) and absence of tender enthesis (OR 1.74 (1.85-2.79)) were independently associated with presence of PASS (Nagelkerke R<sup>2</sup>: 0.38). The ASDAS showed good accuracy to predict PASS, with an AUC of 0.84 (95% CI 0.80-0.85). The optimal cut-off point of ASDAS for presence of PASS was 2.7 (sensitivity 77%, specificity 78%). A total of 214 patients had had an acceptable symptom state but active disease according to the ASDAS cut-off value for active disease of 2.1, this is 44% of patients being in PASS. <h3>Conclusion</h3> In axSpA patients from a standard of care cohort, 76% had an acceptable symptom state. Lower ASDAS, longer symptom duration, and absence of tender enthesis were independently associated with an acceptable symptom state. AxSpA patients experiencing an acceptable symptom state can still have active disease according to the ASDAS. <h3>Reference</h3> [1]Tubach F et al. Arthritis Care Res. 2012;64(11). <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Marlies Carbo: None declared, Anne Kampman: None declared, Davy Paap: None declared, Freke Wink: None declared, Anneke Spoorenberg Paid instructor for: AbbVie, Consultant of: AbbVie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Grant/research support from: Novartis Pharma, Pfizer, Suzanne Arends: None declared.